Unfolding Clinical Reasoning Case Study
Heart Failure/Acute Renal Failure Content/Concept Map
I. Content
Anatomy/Physiology:
Pharmacology:
Labs:
Dosage Calculation:
Nursing Priorities:
Medical Management
Priorities:
Priority Setting:
Which orders do you
implement first and
why?
Patient Education:
 Acute Renal Failure
 Heart Failure
 Atrial Fibrillation
Home Meds:
 ASA 81 mg daily
 Carvedilol (Coreg) 3.25 mg daily
 Ezetimide (Zetia) 10 mg daily
 Hydralazine (Apresoline) 25 mg 4x daily
 Torsemide (Demedex) 20 mg bid
 KCL 20 meq daily
 Warfarin (Coumadin) 5 mg daily
Medical management:
 Lasix IV
 Nitroglycerin IV drip
 CBC
 BMP
 Cardiac (Troponin, CPK, BNP)
 Chest x-ray
 Lasix 40 mg IV push



Improve oxygenation and address underlying impaired gas
exchange by…
DECREASING the workload of the heart
Removing excess fluid volume
Decrease anxiety
Titrate oxygen to keep O2 sat >92%
Furosemide (Lasix) 40 mg IV push
Nitroglycerin IV drip: titrate to keep SBP <130
Strict I&O
Titrate oxygen to keep O2 sat >92%
Furosemide (Lasix) 40 mg IV push
Nitroglycerin IV drip: titrate to keep SBP <130
Strict I&O



Need to decrease sodium in diet
Daily weight
Reinforce EARLY signs of heart failure decompensation









© 2013 Keith Rischer/www.KeithRN.com
II. Concepts (in order of emphasis)
I.
II.
III.
IV.
V.
VI.
VII.
III.
I.
Perfusion
Gas Exchange
Fluid and Electrolyte Balance
Clinical Judgment
Patient Education
Communication
Collaboration
NCLEX Client Need Categories
Safe and Effective Care Environment
a. 20%–Management of Care
i. Providing and directing nursing care that enhances the care delivery
setting to protect clients, family/significant others, and healthcare
personnel
1. Establish priorities
2. Collaboration w/treatment team
3. Advocacy
II.
III.
Health Promotion & Maintenance:
i. 9%–The nurse provides and directs nursing care of the client and
family/significant others that incorporates knowledge of expected growth
and development principles, prevention and/or early detection of health
problems, and strategies to achieve optimal health.
1. Disease prevention
2. Physical assessment
3. Client education
Physiologic Integrity
a. 15%–Pharmacological & Parenteral Therapies:
i. Providing care related to the administration of medications and
parenteral therapies
1. Expected actions, adverse/side effects
2. Medication administration
3. IV therapies
4. Dosage calculation
b. 12%–Reduction of Risk Potential:
i. Reducing the likelihood that clients will develop complications or health
problems related to existing conditions, treatments or procedures
1. Changes in VS
2. Diagnostic tests
3. Lab values
4. System specific assessments
5. Potential for alterations in body systems
c. 13%–Physiological Adaptation:
i. Managing and providing care for clients with acute, chronic, or life
threatening health conditions.
© 2013 Keith Rischer/www.KeithRN.com
1. Pathophysiology
2. F&E imbalances
3. Medical emergencies
IV. QSEN Skills
I.
II.
III.
Patient-centered Care
a. Implementation of care plan and evaluation of care
b. Provide patient-centered care with sensitivity and respect for the
diversity of human experience
Evidence-based Practice
a. Base individualized care plan on patient values, clinical expertise and
evidence
Teamwork and Collaboration
a. Follow communication practices that minimize risks associated with
handoffs among providers and across transitions in care (SBAR). Assert
own position/perspective in discussions about patient care
© 2013 Keith Rischer/www.KeithRN.com